The focus of our TRC network center is on a high-risk yet underserved segment of the e 40 years old population, namely African Americans residing in Jefferson County, Alabama, many of who are uninsured. Rates of vision impairment and eye disease among African Americans are two times higher than those of older whites, especially glaucoma and diabetic retinopathy. The public health challenge is that if these eye problems had been detected early, much of this disease and vision impairment would be reversible and preventable with currently available ophthalmic treatments. Previous research has suggested that African Americans adults are less likely to receive routine, comprehensive eye care, when newly emerging eye conditions could be detected and treated in a timely fashion. The personal burden of eye disease and vision impairment is heavy. Vision impairment causes difficulties in maintaining a high quality of life and hampers reading, mobility, financial management, and engagement in social activities. Persons with vision impairment are at increased risk for depression, transportation challenges, being unemployed, placement into long-term care, injury, and mortality. As a society, the economic burden of vision impairment is staggering. The annual cost of adult vision problems in the U.S. has been estimated to be about $51.4 billion. Many barriers to care likely underlie the exacerbated vision impairment rates in African Americans, including cost, lack of health insurance, communication, trust, and their having an inadequate understanding of how eye diseases can be prevented. Characteristics of the healthcare system itself undoubtedly contribute, such as a shortage of eye care providers who work in geographic areas with high-risk populations, a shortage of clinics that accept patients who are uninsured, insufficient funds to staff these clinics, and associated challenges in following preferred practice patterns to improving outcomes. We have a unique resource here in Alabama to address these pressing issues, through a partnership between the University of Alabama at Birmingham (UAB) and the Cooper Green Hospital/Jefferson Health System (CGH/JHS). CGH/JHS serves all residents of Jefferson County regardless of their ability to pay. About 80% percent of adult patients seen at the CHS/JHS clinics are African American and about 70% have no health insurance whatsoever. Over 60% have been diagnosed with glaucoma or have diabetes or both. Using the CGH/JHS administrative database and our ability to study individual patients in the clinics, our research center will provide information on how to improve access to and the quality of eye care for this underserved population. Studies will focus on primary open angle glaucoma, diabetic eye care, and visually impaired persons in need of rehabilitation services. Our center will also participate in TRC network-wide studies to be designed collaboratively with the other network centers and CDC.